Perceptions in rib injuries: A multidisciplinary single center survey of clinician differences in risk stratification and management of patients with rib fractures

Matthew C Johnson; Claire P Miller; Allan E Stolarski; Ashar Ata; Ashley Bartscherer; Sean P Geary; Carl Rosati; Joseph DuBose; Marcel Tafen; Steven C Stain

doi:10.1016/j.amjsurg.2019.01.016

Perceptions in rib injuries: A multidisciplinary single center survey of clinician differences in risk stratification and management of patients with rib fractures

Am J Surg. 2019 Jul;218(1):32-36. doi: 10.1016/j.amjsurg.2019.01.016. Epub 2019 Jan 23.

Authors

Affiliations

¹ Section of Trauma and Acute Care Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: [email protected].
² Section of Trauma and Acute Care Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: [email protected].
³ Department of Surgery, Boston University Medical Center, Boston, MA, USA. Electronic address: [email protected].
⁴ Section of Trauma and Acute Care Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: [email protected].
⁵ Section of Trauma and Acute Care Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: [email protected].
⁶ Department of Emergency Medicine & Department of Surgery, Division of Surgical Critical Care, Albany Medical Center, Albany, NY, USA. Electronic address: [email protected].
⁷ Section of Trauma and Acute Care Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: [email protected].
⁸ R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA. Electronic address: [email protected].
⁹ Section of Trauma and Acute Care Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: [email protected].
¹⁰ Section of Trauma and Acute Care Surgery, Department of Surgery, Albany Medical Center, Albany, NY, USA. Electronic address: [email protected].

PMID: 30709551
DOI: 10.1016/j.amjsurg.2019.01.016

Abstract

Background: Although associated with significant morbidity, there is no universally accepted management of rib fractures. We hypothesized that variations in risk stratification may influence this.

Methods: A questionnaire was developed to assess providers' perceived risk factors and injury stratification of rib fracture patients at a Level 1 trauma center.

Results: There were 143 responses (36% physician response rate). Hypoxia, age, number of ribs fractured, pre-existing pulmonary disease, and flail chest were identified as the most important risk factors determining morbidity and mortality in blunt chest trauma. While clinicians agreed on predicted mortality for <2 fractured ribs, significant variation for 5-6 and >8 rib fractures was seen. EM and surgery providers significantly differed in assessment of injury severity.

Conclusion: Providers identified common risk factors for increased morbidity and mortality. However, the difference in perceived severity between providers indicates a need for clinical tools to assist in better standardizing rib fracture management.

Keywords: Morbidity; Mortality; Rib fractures.

MeSH terms

Female
Humans
Injury Severity Score
Male
Practice Patterns, Physicians' / statistics & numerical data*
Rib Fractures / mortality*
Rib Fractures / therapy*
Risk Assessment*
Surveys and Questionnaires